Individual provider Active NPI

Vicki L Bralow, DO

  • Family Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1962588335
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0S006570L Issued in PA
Practice address
834 South St
Philadelphia, PA 19147-2025
Phone
(215) 832-0135
Fax
(610) 660-0877
NPI assigned
Oct 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0S006570L PA Primary

Addresses

Primary practice location

834 South St
Philadelphia, PA 19147-2025

Mailing address

200 W Washington SQ Apt 3707
Philadelphia, PA 19106-3538
Phone (215) 832-0135

Other practice location 1

732 S 8th Street
Philadelphia, PA 19147
Phone (215) 922-4707

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101110001067 PA Practitioner - Family Practice 5496940942 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Philadelphia College of Osteopathic Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bralow Medical GroupGroup PAC ID 4880961838, 2 clinicians

Practice addresses (Care Compare)

420 Bainbridge St
Suite 201
Philadelphia, PA 19147-1568
Phone (215) 832-0130

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
0S006570LPAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Philly Wellness Center LLC CurrentSince Nov 26, 2023 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1962588335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W WASHINGTON SQ APT 3707",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191063538",
            "telephone_number": "215-832-0135",
            "fax_number": "610-660-0877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "834 SOUTH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191472025",
            "telephone_number": "215-832-0135",
            "fax_number": "610-660-0877"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "732 S 8th Street",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "19147",
            "country_code": "US",
            "telephone_number": "215-922-4707",
            "fax_number": "215-922-4709",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRALOW",
        "first_name": "VICKI",
        "middle_name": "L",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-28",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "0S006570L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.